Sugar Sugar
He was young, 26 years old. In the ICU that's young and it ups the ante. It's one thing to lose an ancient patient whose time has come. Quite another to lose a young man who should have a full life ahead of him. If you don't screw up that is.
The beeper woke me up from the deepest levels of REM sleep and I was momentarily disoriented. I picked up the alarm first, pressing the snooze control to no effect. Finally, wakefullness intervened and I lit the beeper up. The ER number flashed and I groaned, knowing that my night's sleep was done.
ER speak: 26 yo, type I diabetic. Last heard from 2 days ago. Found down by concerned girlfriend. EMS transported. Intubated in the ER and placed on a mechanical ventilator. Labs barely compatible with life. Blood sugar 1657 (a personal record in my experience), blood pH 6.8. Acute renal failure, coma, hypotension. Blah, blah, blah. I was already tuning it out, planning my counter-attack.
What it all meant was that my night was screwed. Diabetes has many manifestations, but one of the worst is diabetic ketoacidosis or DKA. An absolute lack of insulin sets off a cascade of metabolic disarray that if not diagnosed early and managed carefully resuilts in death. This boy was a late presentation to say the least. Down for two days with blood sugar levels so high I'm suprised his blood didn't crystalize. His blood was dangerously acidotic, his brain wasn't working and his blood pressure was failing. The Angel was definitely in the room, if not sitting on the bed laughing at me.
When I arrived at the Unit, a crowd of family members were wringing their hands in the room. I chased them away with my doctor-on-a-mission mode and got to work: physical exam, check the labs, attempt to decipher the illegible notes of the ER doc, place lines (arterial line, central venous line), adjust the vent, order iv insulin, iv fluids, lab monitoring.
Two hours later I was heading home. The sky was lightening and the birds were beginning to sing. For the now the Angel had been chased out of the room, but it would be several days before the battle was decided. The most difficult part was dealing with the family members after seeing the patient. It was the usual cast of characters: mother who was a nurse with some medical knowledge asking detailed questions, belligerent sister who wasn't going to let any goddam lazy doctor not give her loved one the best of care, silent and distraught father looking on in disbelief as his little boy, the one he taught to throw a baseball just the other day, lay near death, tubes in his lungs, veins, arteries, bladder. Eventually I managed to convince them that I knew what I was doing and that they were going to have to trust me.
Home, bed, wait for the next call.
The beeper woke me up from the deepest levels of REM sleep and I was momentarily disoriented. I picked up the alarm first, pressing the snooze control to no effect. Finally, wakefullness intervened and I lit the beeper up. The ER number flashed and I groaned, knowing that my night's sleep was done.
ER speak: 26 yo, type I diabetic. Last heard from 2 days ago. Found down by concerned girlfriend. EMS transported. Intubated in the ER and placed on a mechanical ventilator. Labs barely compatible with life. Blood sugar 1657 (a personal record in my experience), blood pH 6.8. Acute renal failure, coma, hypotension. Blah, blah, blah. I was already tuning it out, planning my counter-attack.
What it all meant was that my night was screwed. Diabetes has many manifestations, but one of the worst is diabetic ketoacidosis or DKA. An absolute lack of insulin sets off a cascade of metabolic disarray that if not diagnosed early and managed carefully resuilts in death. This boy was a late presentation to say the least. Down for two days with blood sugar levels so high I'm suprised his blood didn't crystalize. His blood was dangerously acidotic, his brain wasn't working and his blood pressure was failing. The Angel was definitely in the room, if not sitting on the bed laughing at me.
When I arrived at the Unit, a crowd of family members were wringing their hands in the room. I chased them away with my doctor-on-a-mission mode and got to work: physical exam, check the labs, attempt to decipher the illegible notes of the ER doc, place lines (arterial line, central venous line), adjust the vent, order iv insulin, iv fluids, lab monitoring.
Two hours later I was heading home. The sky was lightening and the birds were beginning to sing. For the now the Angel had been chased out of the room, but it would be several days before the battle was decided. The most difficult part was dealing with the family members after seeing the patient. It was the usual cast of characters: mother who was a nurse with some medical knowledge asking detailed questions, belligerent sister who wasn't going to let any goddam lazy doctor not give her loved one the best of care, silent and distraught father looking on in disbelief as his little boy, the one he taught to throw a baseball just the other day, lay near death, tubes in his lungs, veins, arteries, bladder. Eventually I managed to convince them that I knew what I was doing and that they were going to have to trust me.
Home, bed, wait for the next call.
posted by ICUDOC at 8:51 PM
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